Undernutrition and suboptimal growth during the first year are associated with glycemia but not with insulin resistance in adulthood

Pereyra, Isabel; López-Arana, Sandra; Horta, Bernardo L.

doi:10.1590/0102-311X00120320

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ARTICLE • Cad. Saúde Pública 37 (7) • 2021 • https://doi.org/10.1590/0102-311X00120320 copy

Undernutrition and suboptimal growth during the first year are associated with glycemia but not with insulin resistance in adulthood

Desnutrición y crecimiento insuficiente durante el primer año están asociados con la glucemia, pero no con la resistencia a la insulina en la etapa adulta

Subnutrição e crescimento baixo durante o primeiro ano de vida estão associados à glicemia, mas não à resistência insulínica na vida adulta

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

This study aimed to assess whether weight, length, and conditional growth during the first year are associated with glycemia and insulin resistance among young adults. A non-concurrent longitudinal design was used in the study. This is a population-based cohort study, composed of people aged from 22 to 28 years. We estimated z-scores from birth to the first year and the infants were classified as stunted, underweight, overweight, obese, wasted, and at risk of wasting, using cut-offs proposed by the World Health Organization (Child Growth Standards, 2006). Conditional weight and length gain variables were estimated. Glycemia, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and single point insulin sensitivity estimator (SPISE) were evaluated in adulthood. Multiple linear regressions that includes the variables associated with glycemia and insulin resistance were used. In total, 1,070 subjects were evaluated and glycemia in adulthood was higher among subjects who were wasted or at risk of wasting at 12 months (β coefficient = 2.77; 95%CI: 0.37; 5.21). In relation to normal weight, those subjects who were overweight at 12 months showed the lowest glycemia (β coefficient = -2.39; 95%CI: -4.32; -0.36). Conditional weight gain in the first year was negatively associated with glycemia in adulthood (β coefficient = -0.65; 95%CI: -1.23; -0.08). SPISE was higher among underweight subjects, and negatively associated with conditional relative weight gain and conditional linear growth in the first year. In conclusion, we found that undernutrition and suboptimal growth were associated with higher glycemia.

Keywords:
Type 2 Diabetes Mellitus; Insulin Resistance; Young Adult; Growth

	Male (n = 468)	Female (n = 602)	All (n = 1,070)
Born
Birth weight (g) *	3,230 ± 560	3,170 ± 510	3,190 ± 540
Length at birth (cm) *	49.60 ± 2.00	49.30 ± 2.10	49.48 ± 2.12
First year
Conditional relative weight gain 12 months (z-score) **	-0.00 ± 1.10	0.00 ± 1.00	0.04 ± 0.97
Conditional linear growth 12 months (z-score) ^,**	-0.20 ± 1.10	0.10 ± 0.90	-0.01 ± 0.95
First semester of life
Conditional relative weight gain 6 months (z-score) ^#	-0.11 ± 1.04	0.08 ± 0.97	-0.00 ± 1.00
Conditional linear growth 6 months (z-score) ^##	-0.21 ± 1.08	0.16 ± 0.90	-0.00 ± 1.00
Second semester of life
Conditional relative weight gain 6 to 12 months (z-score) ^###	0.08 ± 1.08	-0.06 ± 0.93	0.00 ± 1.00
Conditional linear growth 6 to 12 months (z-score) ^§	-0.05 ± 1.08	0.04 ± 0.93	-0.00 ± 1.00
Adulthood
Age (years) *	24.82 ± 1.49	24.55 ± 1.58	24.67 ± 1.55
BMI *	25.79 ± 4.14	26.44 ± 5.17	26.11 ± 4.73
Glycemia (mg/dL) *	87.7 ± 10.4	84.4 ± 8.9	85.70 ± 9.50
Fasting Insulin (µU/mL) *	11.3 ± 4.7	11.7 ± 4.6	11.49 ± 4.65
HOMA-IR *^,§§	2.48 ± 1.20	2.47 ± 1.10	2.47 ± 1.13
SPISE *^,§§§	6.40 ± 1.70	6.50 ± 1.90	6.46 ± 1.83
Percent located at 22-28 years of age
Insulin resistance (HOMA-IR)	33.62	34.77	34.27
Insulin resistance (SPISE)	56.71	53.39	54.83
Prediabetes (fasting plasma glycemia: 100-125mg/dL) *	6.47	2.97	4.49
Diabetes (fasting plasma glycemia ≥ 126mg/dL) *	0.43	0.17	0.28

	Glycemia (mg/dL)		Fasting insulin (µU/mL)		HOMA-IR		SPISE
	β (95%CI)		β (95%CI)		β (95%CI)		β (95%CI)
	Unadjusted	Adjusted	Unadjusted	Adjusted	Unadjusted	Adjusted	Unadjusted	Adjusted
Length-for-age z-scores	p = 0.03	p = 0.11	p = 0.36	p = 0.82	p = 0.24	p = 0.62	p = 0.05	p = 0.09
Stunting	1.74 (0.17; 3.33)	1.20 (-0.34; 2.75)	-0.12 (-0.88; 0.64)	-0.08 (-0.83; 0.65)	0.04 (-0.14; 0.23)	0.04 (-0.14; 0.22)	0.27 (-0.02; 0.57)	0.21 (-0.08; 0.50)
At risk of stunting	-0.40 (-1.73; 0.93)	-0.55 (-1.93; 0.83)	-0.32 (-0.96; 0.33)	-0.36 (-1.02; 0.30)	-0.09 (-0.25; 0.06)	-0.11 (-0.27; 0.05)	0.25 (0.00; 0.50)	0.23 (-0.03; 0.49)
Normal length (reference)	-	-	-	-	-	-	-	-
Weight-for-age z-scores	p = 0.04	p = 0.57	p = 0.33	p = 0.17	p = 0.12	p = 0.28	p = 0.00	p = 0.00
Underweight	0.48 (-2.37; 3.32)	0.83 (-3.73; 2.07)	-0.64 (-2.01; 0.73)	-0.83 (-2.23; 0.56)	-0.09 (-0.42; 0.24)	-0.18 (-0.52; 0.15)	0.81 (0.28; 1.35)	0.82 (0.27; 1.37)
At risk of underweight	1.84 (0.09; 3.38)	1.27 (-0.50; 3.04)	0.37 (-0.47; 1.21)	0.08 (-0.77; 0.94)	0.16 (-0.04; 0.36)	0.09 (-0.11; 0.30)	0.36 (0.03; 0.70)	0.42 (0.08; 0.75)
Eutrophic (reference)	-	-	-	-	-	-	-	-
Weight-for-length z-scores	p = 0.02	p = 0.02	p = 0.50	p = 0.28	p = 0.23	p = 0.33	p = 0.43	p = 0.24
Wasting and at risk	2.77 (0.37; 5.21)	2.67 (0.19; 5.14)	0.93 (-0.77; 1.53)	-0.03 (-1.22; 1.16)	0.18 (-0.10; 0.47)	0.08 (-0.20; 0.37)	0.17 (-0.27; 0.64)	0.27 (-0.20; 0.73)
Overweight and obesity	-2.20 (-4.14; -0.26)	-2.39 (-4.32; -0.36)	-0.31 (-1.24; 0.63)	-0.16 (-1.10; 0.78)	-0.11 (-0.34; 0.12)	-0.10 (-0.33; 0.12)	-0.03 (-0.40; 0.33)	-0.08 (-0.44; 0.30)
Normal weight (reference)	-	-	-	-	-	-	-	-

	Glycemia (mg/dL)		Fasting insulin (µU/mL)		HOMA-IR		SPISE
	β (95%CI)		β (95%CI)		β (95%CI)		β (95%CI)
	Unadjusted	Adjusted	Unadjusted	Adjusted	Unadjusted	Adjusted	Unadjusted	Adjusted
Birth to 12 months
Conditional relative weight gain (n = 1,070) *	-0.73 (-1.31; -0.15)	-0.65 (-1.23; -0.08)	0.03 (-0.36; 0.44)	-0.01 (-0.29; 0.26)	-0.03 (-1.23; 0.08)	-0.01 (-0.12; 0.09)	-0.17 (-0.27; -0.06)	-0.19 (-0.30; -0.08)
Conditional linear growth (n = 1,070) **	-0.26 (-0.84; 0.32)	-0.07 (-0.52;- 0.66)	0.21 (-0.19; 0.61)	0.23 (-0.05; 0.52)	0.00 (-0.10; 0.11)	0.00 (-0.09; 0.11)	-0.12 (-0.23; -0.09)	-0.14 (-0.26; -0.03)
Birth to 6 months
Conditional relative weight gain (n = 925) ***	-0.80 (-1.41; -0.20)	-0.83 (-1.44; -0.22)	0.03 (-0.27; 0.33)	0.07 (-0.22; 0.37)	-0.02 (-0.09; 0.05)	-0.01 (-0.08; 0.06)	-0.15 (-0.27; -0.03)	-0.17 (-0.29; -0.05)
Conditional linear growth (n = 925) ^#	-0.20 (-0.81; 0.41)	-0.21 (-0.83; 0.40)	0.14 (-0.16; 0.44)	0.19 (-0.11; 0.49)	0.01 (-0.06; 0.09)	0.02 (-0.48; 0.10)	-0.10 (-0.22; 0.01)	-0.11 (-0.23; 0.01)
6-12 months
Conditional relative weight gain (n = 925) ^##	-0.12 (-0.73; 0.49)	-0.07 (-0.68; 0.55)	-0.03 (-0.33; 0.27)	0.03 (-0.26; 0.33)	-0.01 (-0.08; 0.06)	0.01 (-0,07; 0.08)	-0.15 (-0.22; 0.02)	-0.12 (-0.23; 0.00)
Conditional linear growth (n = 925) ^###	-0.20 (-0.81; 0.41)	-0.17 (-0.78; 0.44)	0.18 (-0.12; 0.43)	0.19 (-0.11; 0.49)	0.03 (-0.04; 0.10)	0.03 (-0.04; 0.11)	-0.02 (-0.14; 0.10)	-0.02 (-0.14; 0.10)

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[1] Correspondencia
I. Pereyra Universidad Católica del Uruguay. Calle 26 entre C y D, Canelones 15300, Uruguay. ipereyra@ucu.edu.uy